Modeling Professional Attitudes and Teaching Humanistic Communication in VR (MPathic-VR) Patients with life-threatening cancer need caregivers who can help them through difficult decisions by understanding their interests, values, and beliefs, and who communicate empathically with the patient's family and friends, and effectively with their medical peers. Yet medical students, residents, and even oncology fellows lack effective training in such crucial communications. Educators face great difficulty imparting ethical and professional values to medical students in traditional chalk and talk teaching environments. Standardized patient instructors (SPIs) have also been used to evaluate professional competencies, but they can be time- consuming, costly, and perform inconsistently over multiple student encounters. Finally, medical students themselves are generally resistant to educational measures designed to promote ethical practice and reflective professionalism as they lack experience to realize why explicit professional education matters. In Phase I, MCI successfully developed and tested MPathic-VR, a prototype virtual patient educational system designed to address weaknesses in the current medical educational paradigm. In this Phase II project, MCI proposes to greatly enhance the educational breadth and technical sophistication of the Phase I system. At the completion of Phase II, this platform will feature a rich and coherent educational experience relevant to communication in the setting of cancer, and will be tested for effectiveness in a mixed-methods trial in the curriculum of two medical schools. The project has five aims. (1) Expand the Phase I Breaking Bad News design into a more comprehensive training experience that addresses additional Accreditation Council for Graduate Medical Education (ACGME) core competencies. (2) Develop a character animation-authoring framework to enable the rapid creation of highly expressive virtual human characters. (3) Develop capability to capture learners' nonverbal behavior to create a natural, human-like (i.e., bi-directional and multi-modal) interaction between VHs and learners. (4) Implement automated methods to bookmark teachable moments occurring in each learner-VH interaction, and provide learners with summative feedback on their effective/ineffective communications. (5) Demonstrate the effectiveness of the MPathic-VR educational program in a two-armed, mixed-methods trial with a control and an intervention arm at each of two medical schools. In summary, the MPathic-VR program will place lessons about professionalism, empathy, teamwork and patient-centeredness into a context that is both highly engaging and pedagogically solid. The Phase II project will rigorously evaluate the extent to which software program can enhance medical school curricula in the above competencies, and in verbal and non-verbal communication skills. At the end of Phase II, MCW will have created a ground-breaking software program that can be used to teach medical students the ACGME competencies that all physicians should demonstrate when caring for a patient with terminal illness. PUBLIC HEALTH RELEVANCE: Modeling Professional Attitudes and Teaching Humanistic Communication in VR (MPathic-VR) Doctors rarely receive effective training on how to communicate with patients who have terminal cancer, to help them with difficult decisions that have great emotional and financial impacts on the patients and on society. To address this communication failure, Medical Cyberworlds will build on its very successful Phase I Breaking Bad News prototype and develop a revolutionary training platform-with highly expressive virtual patients and other virtual human characters-that will help medical students to develop the insight, skill and competency to handle crucial medical conversations in ways that are patient-centered, caring and competent. Phase II innovations include: (1) a program with rigorous teaching methods to give learners specific, individualized, precise, reproducible, and unbiased feedback, unlike human evaluators; (2) development of tools and techniques to automate normally time- and cost-intensive processes of creating high quality virtual humans; (3) bi-directional operation with software that capture both the learners' selected verbal responses and-through webcam or Kinect-aspects of learners' non-verbal communication; and (4) automated learner assessment and review.